STOP NCDs: Scaling up evidence-based health system interventions Through the use of sustainable healthcare financing and digital technOlogy Platforms to improve Non-Communicable Disease prevention and control in Tanzania

Background

There is a high burden of hypertension and diabetes in Tanzania: Data from the Tanzania STEPS Survey showed that the prevalence of HTN in Zanzibar and mainland Tanzania was 33.5% and 30%, respectively, and, the prevalence of DM in Zanzibar and mainland Tanzania was lower at 4.4% in both Zanzibar and the mainland. Less than 39% of the population were aware they had diabetes or hypertension, and a strikingly low number were involved in primary care to control these conditions. Furthermore, only 10.9% of the hypertensive population were achieving blood pressure control, indicating a significant gap and the need for more evidence-based NCD reduction strategies to improve diagnosis and management of HTN and DM in Tanzania. Barriers and bottlenecks to effective HTN and DM control in Tanzania and other Sub Saharan African (SSA) contexts exist at multiple levels.

Aims

The aim of our proposed program is to develop and implement a multilevel, multicomponent and health-financing intervention that will facilitate the scale up of evidence-based strategies to improve non-communicable diseases prevention, detection and control in Tanzania.

Project plan

We will accomplish this by:

1. Convening a Stakeholder Advisory Board (SAB) and an Implementation Research Learning Collaborative for NCDs Prevention to undertake a pre-formative assessment; and a formative health system capacity and needs assessment for NCD control

2. Using the outputs of Aim 1, adapt two intervention components that are candidates for inclusion in a highly effective optimized strategy (called STOP-NCDs) and; (b) Assess their individual and combined effectiveness,

3. Conduct a robust, mixed-methods evaluation of the implementation process and assess factors that may influence implementation and sustainability for delivering and scaling the optimized STOP-NCDs strategy.

4. We will select and/or adapt intervention components making up the optimized STOP-NCDs strategy.

Using a hybrid clinical-effectiveness implementation design, we will conduct a study in 3 sequential phases:

1. A pre-implementation phase, based on the Consolidated Framework for Implementation Research to determine implementation climate, and organizational capacity within the health facilities (dispensaries, health centers and hospitals) within the iCHF program.

2. A clinical-effectiveness phase in which we evaluate the effect of our combined strategies (task-sharing and WelTel) versus Usual Care, on rates of systolic BP reduction at 12 months; as well as other secondary outcomes including diagnosis and treatment of diabetes and, patient knowledge of CVD risks and prevention, and, other features of health provider NCD prevention activities.

3. A post-implementation phase in which we use the RE-AIM framework to evaluate changes in the adoption and maintenance of our combined strategies in participating iCHF health facilities across Kilimanjaro region.

We will use the WelTel communication and Patient Management platform for to deliver culturally and contextually appropriate evidence-based text messaging to patients. It allows for quality improvement and is a unique tool for our program to scaling low-cost interventions that provide capabilities for tracking of health system service uptake, quality-metrics at health facilities, drug stock-out management, and patient-centered behavioral health interventions. Deployment of WelTel will allow for integration of NCD prevention targeted health services to all adult iCHF members across differing life stages and NCD risk and have a significant impact on increasing quality of care and sustainability of health financing and performance-based incentives through improved prescribing, patient engagement, medication adherence and healthy behaviour change.

Funding organisations

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